An Analysis of the Risk Factors for the Failure of Respiratory Support
With High-flow Nasal Cannula Oxygen Therapy in Children with Acute
Respiratory Dysfunction: a case-control study
Abstract
Objective:High-flow nasal cannula oxygen therapy (HFNC) is a new type of
non-invasive respiratory support technique that widely used in pediatric
intensive care units (PICUs);however,improper use of HFNC is likely to
bring adverse outcomes to critically ill children.Our objective of this
study was to identify the risk factors for the failure of HFNC.Study
design: Divided the patients into different categories: HFNC success
group, a 48h failure group, a 24h failure group, and a 2h failure
group.The clinical indexes and the change trend in HFNC before and after
treatment were dynamically observed in 67 pediatric patients. Risk
factors for HFNC failure were determined using multivariate logistic
regression analysis.Results:PRISM III score>4 points and
PaCO2>43 mmHg were risk factors for 48h failure (OR were
4.064, 4.516, P<0.05); PaCO2>43 mmHg was risk
factors for 24 h failure (OR was 3.152, P<0.05); PRISM III
score>6.5 points and PaCO2/PaO2 ratio>0.67
were risk factors for 2 h failure (OR were 27.977, 64.366,
P<0.05) and the risk of HFNC failure increased more than 5
times when the PaO2/FiO2 ratio decreased by>28% after 2 h
of HFNC treatment, and the invasive mechanical ventilation time was
statistically longer in the patients that upgraded from HFNC to invasive
respiratory support than that of patients who received invasive
respiratory support directly(P<0.05).Conclusions:The PRISM III
score, PaCO2 and PaCO2/PaO2 ratio were risk factors for HFNC
failure.Totally the shorter the failure time, the higher the values of
the risk factors were, and the higher the failure risk of HFNC was. The
change in the PaO2/FiO2 ratio before and after HFNC is a warning
indicator for early HFNC failure. And early HFNC failure might lead to
prolonged invasive mechanical ventilation.